Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The best way to deal with a keloid is not to get one. A person who has had a keloid should not undergo elective or cosmetic skin surgeries or procedures such as piercing. When it comes to keloids, prevention is crucial, because current treatments leave a lot to be desired.
Is keloid removal necessary?
The decision about when to treat a keloid depends on the symptoms associated with its development and its anatomical location. A chronically itchy and irritated keloid can be quite distracting. Keloids in cosmetically sensitive areas that cause disfigurement or embarrassment are obvious candidates for treatment. It is unclear whether early treatment is important. What is clear is that larger keloids are more difficult to treat.
Cortisone injections (intralesional steroids): These are safe and not very painful. Injections are usually given once every 4 to 8 weeks into the keloids) and usually help flatten keloids; however, steroid injections can also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. (These can be treated using a laser; see below.) The keloid may look better after treatment than it looked to start with, but even the best results leave a mark that looks and feels quite different from the surrounding skin.
Surgery: This is risky, because cutting a keloid can trigger the formation of a similar or even larger keloid. Some surgeons achieve success by injecting steroids or applying pressure dressings to the wound site for months after cutting away the keloid. Radiation after surgical excision has also been used.
Laser: The pulsed-dye laser can be effective at flattening keloids and making them look less red. Treatment is safe and not very painful, but several treatment sessions may be needed. These may be costly, since such treatments are not generally covered by insurance plans.
Silicone sheets: This involves wearing a sheet of silicone gel on the affected area continuously for months, which is hard to sustain. Results are variable. Some doctors claim similar success with compression dressings made from materials other than silicone.
Cryotherapy: Freezing keloids with liquid nitrogen may flatten them but often darkens or lightens the site of treatment.
Interferon: Interferons are proteins produced by the body's immune systems that help fight off viruses, bacteria, and other challenges. In recent studies, injections of interferon have shown promise in reducing the size of keloids, though it's not yet certain whether that effect will be lasting. Current research is underway using a variant of this method, applying topical imiquimod (Aldara), which stimulates the body to produce interferon.
Fluorouracil: Injections of this chemotherapy agent, alone or together with steroids, have been used as well for treatment of keloids.
Radiation: Some doctors have reported safe and effective use of radiation to treat keloids.
Previous contributing author: Alan Rockoff, MD
Medically reviewed by Norman Levine, MD; American Board of Dermatology
Shockman, Soloman, Kapila V. Paghdal, and George Cohen. "Medical and Surgical Management of Keloids: A Review." Journal of Drugs in Dermatology 9.10 Oct. 2010: 1249-1257.